As it happens, I was looking through a recent New England Journal of Medicine yesterday after having posted that comment on outsourcing. (Yes, I do read it, even while whacking its editorial staff over the head about the VIGOR study).
There's a fine perspective in there on medical outsourcing, in this case the use of "nighthawk" firms that provide middle-of-the-night radiological opinions. After all, it's during the working day in Bangalore, and X-ray data is just a mass of binary digits like anything else that zips through the Internet, so why not?
The author lists some of the benefits to this (after all, radiologists need to sleep, too), and possible problems with these services, but concludes:
". . .it is easy to rail against this trend or to pray that it all happens after we retire. And observing the snail's pace of the quality, safety, and information-technology movements in health care one might predict that full-blown medical outsourcing is decades away. But judging by the speed with which high-tech call centers have migrated to Bangalore, the pace of change might actually be shockingly rapid.
People and institutions that are harmed by outsourcing will not take it sitting down, and I expect to see a flurry of initiatives to protect the status quo. Physicians and specialty societies will undoubtedly use the tools of legislation, licensure, certification, and reimbursement to thwart perceived threats to their livelihoods. Such efforts will nearly always be framed as protections of quality or patient safety, though some will be difficult to defend against charges of hypocrisy. . .
Though defensiveness and resistance are inevitable, I believe that a more productive strategy is for local caregivers, advocacy groups, and institutions to welcome - or at least accept - outsourcing that serves their patients' interests and to focus their attention on improving the quality and efficiency of the care they themselves deliver. . ."
Which, when you get down to it, is exactly what I was saying yesterday. I'll reiterate that I'm a free-trade advocate. I think that the free movement of goods and services is vital to economic prosperity. In turn, that economic prosperity is vital to keeping people alive and the world in what peace it has. Bastiat was right: when goods don't cross borders, soldiers will.
My opinions on the subject wouldn't be worth very much if they changed just because my industry is being affected. I think that American research firms can compete with anyone in the world, and if anyone would like to displace us as an engine of innovation, they are most welcome to try. We'll all be the better for it.